Little Progress on Alcohol Policy Globally.

A new analysis led by a School of Public Health researcher finds that few countries have adopted effective measures to reduce alcohol consumption, and that alcohol continues as the seventh leading cause of death and disability worldwide, and the leading cause for people 15­–49 years old.

The analysis is part of a commentary in the latest issue of the WHO Bulletin, looking at the effects of the 2010 World Health Assembly’s voluntary Global strategy to reduce harmful alcohol use and calling on the World Health Organization (WHO) to establish a stronger, legally-binding commitment for nations to address alcohol consumption.

“We know how to reduce alcohol problems—the global effort to reduce tobacco consumption and related problems provides a clear roadmap. But that effort took resources and resolve, two elements apparently missing in global attempts to reduce alcohol problems,” says lead author David Jernigan, professor of health law, policy & management.

The analysis used 2015 and 2016 survey responses from more than 170 countries to assess whether they were adopting what WHO has termed the “best buys” for reducing alcohol problems—the most effective and cost-effective approaches. As with tobacco, the authors write, taxing alcohol can reduce consumption across the board, yet in most countries taxes and prices have fallen behind inflation. The survey also found that few countries are addressing alcohol marketing in social media, while the places and times alcohol may be purchased are increasing.

Based on these findings and previous research, the authors conclude that alcohol consumption will likely rise by 17 percent by 2030, while the WHO has set a goal of reducing it by 10 percent by 2025. Increases in consumption and harms are most likely to come in low- and middle-income countries, exacerbating global health disparities, the authors write.

The commentary also examines WHO’s 2018 SAFER initiative, which emphasizes high-impact strategies to help governments reduce alcohol consumption and related problems. As with the 2010 voluntary global strategy, the commentary authors write, the resources provided by WHO to implement SAFER are minimal, and do not begin to compare to the level of effort made by WHO and private philanthropy to address other global health issues such as HIV/AIDS, tuberculosis, and road traffic safety—all of which, they note, are connected to alcohol consumption.

“Alcohol is too often the hidden co-factor. It is a carcinogen, with significant effects on non-drinkers including violence, family disruption, and child abuse,” says Pamela Trangenstein, assistant professor of health behavior at  the University of North Carolina Gillings School of Public Health and the commentary’s co-author.

Jernigan and Trangenstein point to the key turning point in the global fight against tobacco-related disease, when WHO used its rarely-employed treaty-making powers to establish a Framework Convention on Tobacco Control (FCTC). The 168 countries that have signed the treaty have made legally-binding commitments to using effective strategies to reduce tobacco use.

In their commentary, Jernigan and Trangenstein recommend a similar global approach to alcohol. Describing the voluntary actions as failures, and noting that the FCTC took ten years to negotiate, they call on WHO and countries around the world to work towards an international, legally-binding instrument that could help avert millions of deaths.

—Michelle Samuels